This form is a Customer Contact Sheet used to record the details of a customer contact.
New Hampshire Customer Contact Sheet
State:
Multi-State
Control #:
US-TS9065A
Format:
Word;
PDF;
Rich Text
Instant download
Description
How to fill out Customer Contact Sheet?
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FAQ
Update your information online. The quickest way to renew your coverage is online with NH EASY. Simply log into your NH EASYaccount today and update your information or submit the paperwork requested. If you don't already have an account you can create one here.
Who is eligible for New Hampshire Medicaid? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows
Division of Medicaid Services. As Medicaid Director, Henry Lipman is the New Hampshire state lead for coordination with the U.S. Centers for Medicaid and Medicare Services.
Questions? Contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, a.m. to p.m. ET. Contact your local District Office. Visit Related Resources for additional eligibility information.
Main Office Information Telephone: (603) 271-3658. Fax: (603) 271-2110. TDD Access: Relay NH 1-800-735-2964. Email: attorneygeneral@doj.nh.gov.
DHHS is here to help you with... Resources for parents from childbirth to adulthood. Resources and support for adults 60 and older and adults between 18 and 60 with a chronic illness or disability. A federal- and state-funded health care program that serves individuals and families who meet eligibility requirements.
Call the NH Medicaid Provider Call Center if you have questions while doing your Revalidation: 866- 291-1674.
NH Healthy Families provides health care coverage for NH Medicaid and Granite Advantage Health Care Program (Granite Advantage). The Department of Health and Human Services (DHHS) decides who is eligible for this program.
